Healthcare Provider Details

I. General information

NPI: 1497779748
Provider Name (Legal Business Name): KATE L MILLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN L MILLER OD

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W KEETOOWAH ST
TAHLEQUAH OK
74464-3497
US

IV. Provider business mailing address

1640 W KEETOOWAH ST
TAHLEQUAH OK
74464-3497
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-2250
  • Fax: 918-456-2251
Mailing address:
  • Phone: 918-456-2250
  • Fax: 918-456-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOK 2111
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: